Preventing Childhood Injury

The Role Of The Emergency Physician

Cowden, John D MD
Dowd, Denise M. MD, MPH
Cantrill, Stephen V MD, FACEP
Witt, Michael MD, MPH, FAAP

¹Authors
²Co-Director, Center for Childhood Safety, Children's Mercy Hospital, Kansas City, MO
³Chief, Section of Injury Prevention, Division of Emergency Medical Services, Children's Mercy Hospital, Kansas City, MO
⁴Peer Reviewers
⁵Associate Director, Department of Emergency Medicine, Denver Health Medical Center, Denver, CO
⁶Attending Physician, Division of Emergency Medicine, Children's Hospital Boston; Instructor of Pediatrics, Harvard Medical School, Boston, MA

Date of original release: October 1, 2007.

Date of most recent review: September 10, 2007.

Termination date: October 1, 2010.

Eligible for 4 CME credits.

See “Physician CME Information” on back page.

Pediatric Emergency Medicine Practice 4(10):p 1-15, October 2007.

A five-year-old boy arrives in the ED by ambulance from the scene of a motor vehicle crash. He was a back-seat passenger wearing a lap belt in a car that struck another car head-on. Both cars were traveling approximately 50 miles per hour. His seven-year-old brother, also wearing a lap belt, was pronounced dead at the scene. His parents, who were belted in the front seat, suffered minor injuries and are being treated at another ED nearby.

The boy arrives tachycardic and in mild respiratory distress, with diminished breath sounds on the left, a linear ecchymotic area across the upper abdomen, and midline tenderness over the lumbar spine. Laboratory evaluation reveals a hemoglobin of 6.8 g/dL and hematuria on urinalysis. His chest x-ray is consistent with traumatic diaphragmatic hernia with the stomach bubble visible in the left chest, mediastinal shift to the right, and a pneumothorax on the left. Lumbar and thoracic spine radiographs show compression fractures of the first and second lumbar vertebrae.

“All the hallmarks of ‘seat belt syndrome,’” the trauma surgeon points out to you. “We've got to teach parents that it's not enough just to buckle their kids up,” he says, frustrated, as he heads to the operating room to explore and repair the boy's internal injuries. You wonder what to say to the boy's parents. Did they know that a booster seat might have prevented these injuries and might have saved their other son's life? Maybe they think this was just an unlucky accident - awful, but unavoidable. Is this the right time to counsel them? Whose job is it to teach or ask families about safety? When is there time for injury prevention when the waiting room is full? And even if there was time, what works? Discouraged, you pick up another chart and read about your next patient: a two-year-old girl with a facial scald from coffee left on the edge of a kitchen counter…